Many small drops of goodness create an ocean of positive change

Mighty oaks from little acorns grow. Likewise, a creative kernel of an idea can lead to great improvements in working practices and service delivery, and a number of colleagues have been exploring their creativity to come up with small changes or initiatives that have led to big results. Some involve using technology to implement new systems that have streamlined work processes, while other ideas – such as displaying posters to remind staff about the importance of patient safety and DIY a comments box to offer a valuable new channel of communication – are reinforcing standards of service quality.

We hope these stories of staff ingenuity included in our Cover Story this month will provide you with inspiration and incentive to make your own contributions to further enhancing our services – every little helps!

Better pharmaceutical product tracking comes with a 'beep'

As part of the Hospital Authority’s continuing efforts to enhance patient safety, the Chief Pharmacist’s Office launched the Supply Chain Modernisation Project in 2010.

By replacing the old system of manually checking pharmaceutical orders along the supply chain with one that relies on internationally recognised scanning barcode system, the project has improved the ease, efficiency and accuracy of making and monitoring drug purchases from order placement to delivery. The success of the project gained it a ‘Healthcare Best Provider Implementation Case Study Award’ from the Hong Kong branch of international supply chain standards organisation, GS1.

Every time an order is placed with a supplier, the department that made the order will receive an electronic confirmation document which is used to verify details such as the name and manufacturer of the product, the country of origin, the quantity ordered and the expiry date before the order is dispatched for delivery. When the order arrives at the hospital, its barcode is scanned to cross-check that its contents match those listed in the original purchase order.

“The system might appear straightforward to the outside eye, but it is a complex combination of interrelated parts with small-but-crucial details. Managing the process involves dealing with over 150 drug suppliers, all the public hospitals in Hong Kong, over 100 pharmacies and stores,” says Chiang Sau-chu, Senior Pharmacist of Pharmacy Informatics and Automation Technology and person-in-charge of the project.“ In the early stages, we had to talk with all HA’s suppliers one by one to ensure their systems could accommodate any changes necessary to meet our new needs.”

The barcode system has now been installed in all public hospitals, with the purchasing and installation of various types of new software and hardware, increasing manpower resources and making improvements and modifications to supplies storerooms.

Chiang added,“we will continue to develop the system and hope that to the system can help trace the drug supply to the patient’s level in the future.”

The project helps to enhance the patient safety and gained a ‘Healthcare Best Provider Implementation Case Study Award’ from the Hong Kong branch of international supply chain standards organisation, GS1.

Supplies specialists ease burden on frontline staff

The traditional system for ensuring that wards maintained a sufficient supply of key items, such as personal protection equipment, medical consumables, Central Sterile Supplies Departement's pre-sterilised disposal items and linen items, involved frontline healthcare workers taking monthly turns to perform inventory counts, order and stack supplies, and check relevant existing items for product availability, integrity and expiry dates. To reduce the burden created by these time-consuming duties, the Business Support Services Department at Hospital Authority Head Office last year pilot-tested an auto-refill service in Kowloon Central and New Territories East clusters, under which specialists were assigned to handle these supply-related tasks on a weekly or daily basis. This more systematic approach to inventory management is not only assisting frontline staff in terms of workload, but has also greatly reduced instances of inadequate or excessive ward supplies.

The success of the Government-funded initiative has resulted in the application of additional funds to implement the system in HA’s other clusters next year.

Jessie Wong, Ward Manager of the Medicine Department at Queen Elizabeth Hospital (QEH) gives the new system her seal of approval. “Removing this burden has meant frontline healthcare workers can spend more time taking care of patients,” she says. “Regular monitoring of supplies by assigned specialist staff has improved inventory management and reduced waste by ensuring items with a limited shelf life are used before the expiry date. The items are also better organised and easier to find.”

At QEH, the service manages over 400 types of items through around 110 locations, providing coverage that currently includes the majority of wards. Every specialist supplies colleague handles eight to nine wards a day and is required to undertake three months of related training that includes three rounds of tests to assess their store items handling skills.

The introduction of specialists to handle the ordering, organising and monitoring of supplies has helped reduce the workload pressure on frontline healthcare staff.
Supplies staff are doing the test to make sure the store items are correct.

Patients benefit from coordinated management of operating theatre facilities

An initiative to make better use of its operating theatre (OT) facilities is benefiting patients through more effective resource allocation and increased efficiency among staff. A dedicated Pilot OT office was established in Hong Kong West Cluster (HKWC) last year to coordinate OT services among HKWC hospitals with the goal of increasing OT throughput.

“Every week, we draw up a schedule that shows the arrangements for each of the 20 OTs at Queen Mary Hospital (QMH),” explains Dr Hung Kwan-ngai, Cluster Coordinator of the office and leader of this pilot programme. “We reserve OTs for emergency cases and we have hired 16 additional nurses to cope with any abrupt or unforeseen increase in demand for OT services.”

Resulting benefits include the ability to arrange for certain operations to take place at QMH when other hospitals are undergoing renovation – as was recently the case at Grantham Hospital and Duchess of Kent Children’s Hospital at Sandy Bay, Dr Hung says. To provide patients with more timely treatment, simple operations such as varicose vein surgery can then be conducted at smaller-scale hospitals.

Positive effects of the programme include a great reduction in the number of elective surgery cancellations, which were periodically bumped from the schedule by emergency liver transplant cases at QMH. The cancellation rate has decreased from 24 four-hour sessions in 2011 to just eight sessions last year, and is currently at zero for the year to date.

Another improvement has been the significant increase in on-time patient arrivals at the OT – from 31% in 2011 to 80% in 2013. “This is very important. If the patient arrives late at the OT, it doesn’t just waste precious surgery time – it affects the morale of the surgery team who all feel they could be making use of that time to serve other patients,” Dr Hung explains.

The HA Committee on Pilot OT Office will use the data and experience gained from the pilot programme at HKWC to develop management tools for improving OT services and will implement the tools in other clusters.

Tablet innovation in the operating theatre

Part of the peri-operative practice at Prince of Wales Hospital required operating theatre staff to take a verbal countercheck of medical instruments using instrument books – calling out the type and number of the instruments required for the surgical procedure. In mid-2013, the operating theatre introduced the use of tablet devices to undertake surgical instrument counts – a significant improvement on the verbal counting method to replace the previous simple instrument checklists with no visual references. Under the new system, information about the type and quantity of instruments required – including reference images – is easily available with just a few taps of the tablet screen. The new process has not only streamlined the instrument-checking procedure but has also enhanced surgical safety standards for patients.

Three simple steps lead to fewer falls

A one-month fall prevention programme ran in July last year in the clinical oncology ward at Prince of Wales Hospital successfully cut the number of patient falls from 22 in the first half of 2013 to six in the second half. Measures taken during the programme included arranging supporting staff to patrol the ward 10 times a day to handle patient needs, putting a list of the bed numbers of high-risk patients on the ward noticeboard to alert staff to take extra attention and placing posters and slogans in prominent places around the ward and in the bathroom areas to reinforce staff and remind patients alertness of fall.

Message boxes enhance patient-practitioner communication

To facilitate communication between patients and medical practitioners, North District Hospital has implemented a ‘leave a message’ programme. A comments box has been put in every ward through which patients and their relatives can make enquiries during the busy hours in the ward, and colleagues can give a quick response to patient's families. Messages are collected three times each day and are followed up by the staff on shift. The date of the message and the action taken is recorded. Handled messages are then chopped and passed to the ward manager for monthly collation and analysis by Central Nursing Division.